Aceh Free Pasung: Releasing the mentally ill from physical restraint

This is a cross-sectional descriptive study conducted at the Banda Aceh Mental Hospital, where people who had been restrained or confined in the community are being admitted for psychiatric treatment and, where necessary, physical rehabilitation, as part of the Aceh Free Pasung program.Fifty-nine of former ex-pasung patients were examined. The majority (88.1%) of the patients were male, aged 18 to 68 years. The duration of pasung varied from a few days to 20 years, with a mean duration of 4.0 years. The reasons for applying pasung are many, with concerns about dangerousness being most common. The great majority (89.8%) had a diagnosis of schizophrenia.The development of a community mental health system and the introduction of a health insurance system in Aceh (together with the national health insurance scheme for the poor) has enabled access to free hospital treatment for people with severe mental disorders, including those who have been in pasung. The demographic and clinical characteristics of this group of ex-pasung patients are broadly similar to those reported in previous studies.The Aceh Free Pasung program is an important mental health and human rights initiative that can serve to inform similar efforts in other parts of Indonesia and other low and middle-income countries where restraint and confinement of the mentally ill is receiving insufficient attention.The prevalence of mental illness in Aceh (14.1% of the population of 4.2 million) is higher than the mean prevalence for Indonesia (11.6%). The prevalence of severe mental disorders in Aceh is 1.8% [1]. Multiple factors are thought to contribute to this observation, including poverty, the devastation caused by the 2004 tsunami [2,3] and particularly high levels of mental disorder in the areas most affected by the long-running military conflict [4].While the need for mental health services is great, development of community mental health services only commenced in the post-tsunami period [2,5], and there